Monday, 8 February 2010

Sir Richard Dannatt calls for more help for traumatised veterans

Sir Richard Dannatt spoke at the inauguration of PTSD-Resolution, as he helped us to launch the Resolution formally as an independent charity.
Sir Richard said cases of post traumatic stress diagnosed so far were only the tip of the iceberg. "These are hidden injuries," he said. He welcomed that serving soldiers were now trained to spot the symptoms of battle stress in comrades and contrasted that with his experience as a young officer, decorated for bravery in Northern Ireland.
"In South Armagh, where a company commander was blown up in front of us, we called in all patrols, opened the bar and got smashed. There has to be a better way," he said.

What does the success rate mean.

What percentage of clients actually get better? This is a big question for any treatment service, but there is no single answer because there are different ways of addressing the question. Does it mean what percentage of the whole population would get better using this treatment, or what percentage of those who make an initial enquiry to this service, or what percentage of those who start treatment, or what percentage of those who finish treatment in a planned way with a final assessment?

The picture is complicated by the specialised meaning attached to the word effectiveness. In medicine the word effectiveness relates to how well a treatment approach works in routine clinical practice, but efficacy is how well it works in specific conditions, for example in a clinical trial where certain patients, e.g. those with other disorders, are excluded because they would complicate the picture (and reduce the efficacy).

It is worth pointing out that the Resolution figure of better than 80% 'success' is not a measure of effectiveness in the clinical sense - it will take larger-scale research (for which we are now planning and raising funds) to establish that. Nor, on the other hand, is it a measure of efficacy, as we do not exclude people from the figures because they have other problems that might complicate treatment.

The Resolution figure of 80% is a measure of the outcomes from completed cases. We scale symptoms on first meeting, and scale them again at the last session. The data necessarily excludes those who come along for an assessment and then disappear, but it includes everyone else. If you are following this because you are interested in the outcome for this particular variant of trauma-focussed CBT you might well wonder whether there is something about the patient group that produces this result. It has been suggested, for example, that ex-military people might have more motivation to get better than the general population, and that might be true, and might be pushing the figure up. On the other hand, we could make it higher still by applying exclusion criteria to the service; refusing to take on people with drug or alcohol problems, or personality disorders, for example, and that we will not do.

This raises the question of what exactly are we measuring here, is it the clients or the treatment, and the answer is a combination of both. In other words, if you are an ex-military person with post-traumatic symptoms and you come to Resolution, present indications are that there is a strong probability that your symptoms will come down to a level where they are not considered to need further treatment.

The other question, perhaps more important, is what happens to the others, why do some people not go further than the initial assessment. At the moment we just do not know.

One of the main objects of Resolution is research, and this year we hope to see the first research project on this question.